Basic Information
| Provider Information | |||||||||
| NPI: | 1891253746 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | TAYLER | ||||||||
| MiddleName: | RAYANNA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 MARINER HEALTH WAY STE 213 | ||||||||
| Address2: | |||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042174259 | ||||||||
| FaxNumber: | 9042174251 | ||||||||
| Practice Location | |||||||||
| Address1: | 4320 A1A S STE 7 | ||||||||
| Address2: | |||||||||
| City: | SAINT AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320807436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046793449 | ||||||||
| FaxNumber: | 9046793436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT34469 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.